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PURPOSE Evaluation of CT cholangiography compared to i.v. cholangiography concerning its diagnostic value before laparoscopic cholecystectomy and optimisation of CT cholangiography. METHOD I.v. and CT cholangiographies of 54 patients were retrospectively evaluated by two radiologists. The time interval between contrast infusion and CT was correlated with the assessment of CT cholangiographies to detect the optimal timing for CT scanning. RESULTS CT cholangiography was judged to be generally better than i.v. cholangiography. The optimal time interval for CT scanning is between 30 min and 60 min post contrast infusion. CONCLUSION CT cholangiography should replace the conventional tomograms if i.v. cholangiography does not yield sufficient depiction of the biliary tree. It should be performed within 60 min post contrast infusion. Complete abolishment of i.v. cholangiography is not warranted. This is due to the fact that conventional cholangiography can sufficiently delineate the biliary tree and thereby reduce x-ray exposure and cost compared to initial performance of CT cholangiography.

Volumetric computed tomography (CT) scans ("spiral CT") were performed after intravenous (i.v.) cholangiography followed by additional 3D surface reconstructions of gallbladder and biliary ducts. 34 patients were investigated prior to cholecystectomy. No allergic adverse reactions were observed. The scan time was 24 s. Contrast enhancement in the extrahepatic bile duct and gallbladder were measured. All CT image series were reviewed independently by four experienced physicians (two radiologists, two surgeons) and compared for quality with conventional cholangiography on a three-point scale. The average rating for the demonstration of the biliary tract was significantly better for spiral CT than for conventional cholangiography (p < 0.01). In all cases sufficient contrast was found in the common bile duct (mean 315 HU). 3D imaging was considered to be helpful for intraoperative orientation during laparoscopic surgery. Cholangiography prior to hepatobiliary surgery is important, particularly if minimally invasive laparoscopic techniques are used. The most important questions for the radiologist concern: (1) obstructions or calculi in the ductal system and the gallbladder; (2) the anatomy of the right hepatic duct and the cystic duct (Gotz et al, 1991). To answer these questions, intravenous cholangiography employing conventional tomography is usually performed. The quality of the examination can be diminished by superposition of faeces or gas and small intraductal calculi may be

The potential of the generic kaopectate (Upjohn) as a negative rectal contrast agent in MR imaging was investigated in the assessment of colorectal disease. 45 MR examinations in patients with colorectal disease (colorectal carcinoma 25 patients, inflammatory disease 12 patients, miscellaneous disorders of the colon 8 patients) were evaluated. All examinations were performed with T1 and T2 weighted SE sequences after rectal application of kaopectate. Gd-DTPA enhanced T1 SE sequences were obtained as well. Kaopectate revealed a signal void of the lumen of the large intestine in T1 and T2 weighted SE sequences. Intravenous administration of Gd-DTPA enabled good differentiation of contrast-enhanced malignant or inflammatory tissue and the low signal lumen of the bowels. No side effects were noted.

Forty seven patients with suspected malignant disease (mainly colorectal cancer) were studied with 111In labelled F(ab')2 fragments of an anti-CEA monoclonal antibody (BW 431/31). The kinetic data revealed a long whole body retention of the label (62% after 4 days) and a rapid blood clearance (77% within 24 h, 89% within 48 h) leading to an early positive tumour contrast 24 h p.i. and optimal scintigrams 48 h p.i. Diagnostic results were promising in local recurrences of colorectal cancer (8/10 positive = 80%) though false positive findings in patients with inflammatory bowel disease occurred probably due to cross-reaction with a human granulocyte antigen. Liver metastases and tumours neighbouring liver and spleen were often missed (10/27 = 37%) because of high nonspecific uptake in these organs. Thus BW 431/31 proved to be a suitable compound for radioimmunodetection, however, further improvements to optimize tumour affinity and specificity of the antibody are mandatory.

Summary Background Increased blood pressure is the biggest contributor to the global burden of disease and mortality. Data suggest that less than half of the population with hypertension is aware of it. May Measurement Month was initiated to raise awareness of the importance of blood pressure and as a pragmatic interim solution to the shortfall in screening programmes. Methods This cross-sectional survey included volunteer adults (≥18 years) who ideally had not had their blood pressures measured in the past year. Each participant had their blood pressure measured three times and received a a questionnaire about demographic, lifestyle, and environmental factors. The primary objective was to raise awareness of blood pressure, measured by number of countries involved, number of people screened, and number of people who have untreated or inadequately treated hypertension (defined as systolic blood pressure ≥140 mm Hg or diastolic blood pressure ≥90 mm Hg, or both, or on the basis of receiving antihypertensive medication). Multiple imputation was used to estimate the mean of the second and third blood pressure readings if these were not recorded. Measures of association were analysed using linear mixed models. Findings Data were collected from 1 201 570 individuals in 80 countries. After imputation, of the 1 128 635 individuals for whom a mean of the second and third readings was available, 393 924 (34·9%) individuals had hypertension. 153 905 (17·3%) of 888 616 individuals who were not receiving antihypertensive treatment were hypertensive, and 105 456 (46·3%) of the 227 721 individuals receiving treatment did not have controlled blood pressure. Significant differences in adjusted blood pressures and hypertension prevalence were apparent between regions. Adjusted blood pressure was higher in association with antihypertensive medication, diabetes, cerebrovascular disease, smoking, and alcohol consumption. Blood pressure was higher when measured on the right arm than on the left arm, and blood pressure was highest on Saturdays. Interpretation Inexpensive global screening of blood pressure is achievable using volunteers and convenience sampling. Pending the set-up of systematic surveillance systems worldwide, MMM will be repeated annually to raise awareness of blood pressure. Funding International Society of Hypertension, Centers for Disease Control and Prevention, Servier Pharmaceutical Co.